Paediatric group A streptococcal disease in England: a primary care perspective – Authors' reply

We read Richard Armitage's reflections on the UK response to the surge in group A streptococcal (GAS) disease in children and entirely agree that, in this challenging situation, there was a need for the public health response to balance important communications against the risk of deepening existing anxiety in parents and adding pressure on an already stretched health service. These types of public health decisions are not straightforward and were not taken lightly. In the face of surveillance showing high and escalating levels of GAS disease, including severe illness and death (appendix p 2), and increasing concern from clinicians and the public, the view of the multistakeholder team managing this incident was that a public and professional alert was necessary. These communications were first issued on Dec 2, 2022, which increased the already rising demand for emergency department and general practitioner consultations for scarlet fever and sore throat in children. 1 UKHSASyndromic surveillance: systems and analyses. https://www.gov.uk/government/collections/syndromic-surveillance-systems-and-analysesDate: 2023 Date accessed: January 16, 2023 Google Scholar Alongside raising awareness, and consistent with WHO recommendations, 2 McGuire E Time to negative throat culture following initiation of antibiotics for pharyngeal group A Streptococcus: a systematic review and meta-analysis to inform public health control measures. medRxiv. 2022; (published online Nov 8.) (preprint)https://doi.org/10.1101/2022.11.08.22282068 PubMed Google Scholar , 3 WHOIncrease in invasive Group A streptococcal infections among children in Europe, including fatalities. https://www.who.int/europe/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalitiesDate: 2022 Date accessed: January 12, 2023 Google Scholar National Health Service (NHS) England, the UK Health Security Agency, National Institute for Health and Care Excellence, Royal College of General Practitioners, Royal College of Paediatrics and Child Health, and Royal Pharmaceutical Society issued interim prescribing guidance to temporarily lower clinical thresholds for antibiotic treatment for tonsillitis, pharyngitis, and scarlet fever with the aim of preventing invasive GAS infection in cases and, by interrupting transmission, among immediate contacts and the wider community. 4 Chalker V Jironkin A Coelho J et al. Genome analysis following a national increase in Scarlet Fever in England 2014. BMC Genomics. 2017; 18: 224 Crossref PubMed Scopus (44) Google Scholar , 5 Watts V Balasegaram S Brown CS et al. Increased risk for invasive group A Streptococcus disease for household contacts of Scarlet fever cases, England, 2011–2016. Emerg Infect Dis. 2019; 25: 529-537 Crossref PubMed Scopus (16) Google Scholar Paediatric group A streptococcal disease in England: a primary care perspectiveShamez N Ladhani and colleagues1 detailed the current situation regarding paediatric group A streptococcal (GAS) disease in England through a public health lens. I offer two observations of the same situation from a front-line clinical perspective, acquired from my working in a primary care clinic dedicated to locally tackling the problem in an inner city in England. Full-Text PDF Paediatric group A streptococcal disease in England from October to December, 2022Since October, 2022, England has been experiencing a national increase in group A streptococcal disease in children, including scarlet fever, pneumonia with empyema, and other invasive group A streptococcal disease presentations.1 Current seasonal rates are higher than would be expected for this time of the year when compared with disease incidence before the COVID-19 pandemic and has been associated with increased primary care consultations for pharyngitis and scarlet fever in children and adults across all English regions. Full-Text PDF